from cole, m. applied theories in occupational therapy: a practical approach instructor's...
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From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Motor Control Approaches
Neurodevelopmental Theorists/Theories: Catherine Trombly, Task-Focused,Motor Learning, Margaret Rood,
The Bobaths (NDT), Signe Brunnstrom, PNF, Carr & Sheppard
Reference: Cole & Tufano, Chapter 19
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
FOCUS
Neuroanatomy & Neurophysiology Principles of Neuroscience Treatment of paralysis, flaccidity & spasticity
of muscles resulting from damage or disease to the central nervous system
Treatment of Movement disorders Framework focus: body structures, body
functions, process skills, contexts, and activity demands.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Basic Assumptions
Each theorist has a somewhat different approach, assessment technique, and intervention strategies.
Most neurodevelopmental approaches require specialized training.
These theorists use a behavioral learning approach to motor control based on the sequence normal developmental.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assumptions: Traditional Theories
The remainder of the theories are currently known as “hierarchical” or “traditional” theories of motor control, including Rood The Bobaths – NDT Brunnstrom Proprioceptive Neuromuscular Facilitation (PNF) Carr & Shepherd
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Basic Assumptions, cont.
Margaret Rood, the earliest theorist, is both an occupational and physical therapist. She stresses the importance of early reflexes in the relearning of motor control.
Rood first used her techniques effectively with children with cerebral palsy.
She believed that a baby uses reflexes to move initially but modifies them and eventually replaces the reflexes with voluntary movement.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, 4 Basic Principles
Sensory input is required for normalization of tone and evocation of desired muscular responses.
Sensory motor control is developmentally based.
Movement is purposeful, engagement in activities is required to produce a normal response.
Repetition of movement is necessary for learning.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, cont.
Facilitation techniques: light stroking, brushing, icing, and joint compression are used to facilitate movement.
Inhibition techniques: joint approximation (light compression), neutral warmth, pressure on tendon insertion, and slow rhythmical movement are used to inhibit unwanted movement (i.e., spasticity).
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood identified 8 ontogenetic motor patterns in the following sequence
1. Supine withdrawal
2. Segmental rolling
3. Pivot prone (prone extension)
4. Neck co-contraction
5. Supporting self on elbows
6. All fours movement patterns
7. Standing
8. Walking
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Rood, cont.
Positioning is a primary concern, especially when little voluntary control exists.
Extensive use of mats, bolsters, balls, and other specialized equipment is common in the Rood approach.
Movement patterns can be incorporated into games, such as tug of war, to provide an occupational focus to regaining motor control.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
The Bobaths, Drs. K. (physiologist) & B. (physiotherapist), British - 1948 AKA Neurodevelopment Treatment (NDT) Originally designed their therapy techniques
for persons with hemiplegia (caused by CVA, or stroke)
Also worked with children with cerebral palsy NDT focuses on the sensation of movement;
it is not movement itself, but the sensation of movement, that is learned and remembered
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Bobaths, cont.
Reflex inhibiting postures are used to inhibit primitive reflexes (RIPs).
Sensory stimulation is regulated with great care. Weight bearing, placing and holding, tapping and joint
compression are used to activate normal movement and posture.
Compensation (such as one-handed feeding and dressing) using the noninvolved side is discouraged during recovery from stroke because it results in inactivity and poor recovery on the involved (paralyzed) side.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Brunnstrom, Signe - physical therapist, 1950-1970s Focuses on reflexes which provide the components
of normal movement Proprioceptive (resistive) & exteroceptive (tactile)
stimulation are used to elicit reflexes in the recovering adult hemiplegic
Patients are encouraged to think about the movement and to gain control
Brunnstrom also uses associated reactions and synergies
A synergy is a total flexion or extension movement of a joint or limb
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Brunnstrom’s 6 Stages of Recovery
1. Flaccidity, no voluntary movement
2. Synergies or minimal voluntary movement
3. Synergies performed voluntarily
4. Some deviation from synergy
5. Independent or isolated movement
6. Individual joint movement nearly normal with minimal spasticity
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Proprioceptive Neuromuscular Facilitation (PNF) Developed by Herman Kabat, PhD, MD and
modified by many contributors since the ’40s Uses diagonal & spiraling patterns of
movement Guides thinking about the sequence of
normal development Eleven basic principles (see Cole, p. 242) Uses two diagonal patterns crossing the mid-
line for each major body part, often incorporating verbal commands.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherd’s Motor Relearning Programme (for persons with stroke) Contemporary approach (1990s) Uses dynamical systems model of motor
control Emphasize interaction between performer
and environment Does not accept the hierarchical sequence of
motor relearning proposed by other theorists Like other theorists, Carr & Shepherd
discourage the early use of compensatory strategies
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherd, cont.
Clients taught to avoid abnormal compensation for weak muscles
Treatment techniques based on extensive study of how normal movement occurs during functional tasks
Acknowledge critical role of cognition in motor learning
Movement patterns practiced in context of tasks, rather than exercises
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Carr & Shepherd, 7 Categories of Functional Daily Activities
1. Upper limb function
2. Orofacial function
3. Sitting up over the side of the bed
4. Balanced sitting
5. Standing up & sitting down
6. Balanced standing
7. Walking
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Function and Dysfunction
Function assumes the ability to plan and execute normal voluntary movement
Dysfunction is viewed as neurophysiologically based; CNS deficits result in abnormal muscle tone and lack of voluntary purposeful movement
Each theorist has a separate way to measure the extent of dysfunction
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Change
Changes in motor control are physiologically induced. Engagement in activity can produce physiological
change leading to motor control Individuals relearn movement patterns in a
predictable developmental sequence Theorists differ in the use of early reflexes to produce
movement Handling, sensory stimulation, and manipulation of
affected muscles can facilitate motor relearning
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assessment and Treatment
Specific to each theorist These “traditional” models have also been
called “reflex-hierarchical” or “neuromaturational” because they are based on “relearning” movement in a normal developmental sequence.
New evidence tends to disprove the effectiveness of these approaches.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Transition from Motor Control to Motor Learning Began in 1990s with classic article by
Mathiowetz & Bass Haugen, and Trombly’s Slagle Lecture.
The following introduces Trombly’s model as changing OT’s thinking about establishing or restoring voluntary movement.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Task Focused Approach: Trombly
Occupational Functioning Model – introduced in 1995
Descending hierarchy of tasks & roles Goal is to develop competency & self-esteem Context & environment surround and -
permeate all levels of the hierarchy When clients have mastered the foundation
capacities, they move on to task-focused interventions (individual or group)
Trombly calls this “occupation as end”
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Task Focused Approach, cont.
Five general principles: 1. Client centered focus 2. Occupation based focus 3. Person & Environment – enablers/barriers 4. Practice & Feedback - encoding 5. General treatment goals – role fulfillment,
problem-solving skills re: best way to accomplish valued tasks
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Dynamical Systems Theory & Trombly Applied to physical disabilities, this theory
combines reflexive and voluntary motor control
CNS receives/interprets multiple cues from the environment and involves multiple subsystems when planning to reach desired goals (preferred tasks & roles)
Occupational performance is a product of the interaction between the person, the task, and multiple environmental factors.
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
Assumptions: Task Focused Approach
Trombly’s task focused approach is based on theories of motor learning and dynamical systems theory.
Meaningful tasks are graded and sequenced according to each client’s needs & abilities.
Each task requires experimentation using different strategies & contexts in order for motor skills to be learned.
Currently the preferred approach in OT for intervention after stroke/CNS damage
From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
The End
Next time: Motor Learning Frame of Reference in OT